Immediate treatment effects of high-dose methotrexate and cranial irradiation on neuropsychological functions of children treated for acute lymphoblastic leukemia at a regional cancer center

• Published in: Indian journal of medical and paediatric oncology Vol. 35; no. 4; pp. 281 - 287
• Main Authors: Chidambaram, Sundaramoorthy, Seshachalam, Arun, Elangovan, Vidhubala, Rajendranath, Rejiv
• Format: Journal Article
• Language: English
• Published: A-12, 2nd Floor, Sector 2, Noida-201301 UP, India Thieme Medical and Scientific Publishers Pvt. Ltd 01.10.2014; Medknow Publications and Media Pvt. Ltd; Medknow Publications & Media Pvt. Ltd; Medknow Publications & Media Pvt Ltd
• Subjects: Academic achievement; Acute lymphocytic leukemia; Age; Analysis; Cancer; Cancer therapies; Care and treatment; Children & youth; Dosage and administration; Drug therapy; Methotrexate; Nervous system; Original; ORIGINAL ARTICLE; Pediatrics; Radiation therapy; India; cranial radiation; neuro-cognitive functions; central nervous system prophylaxis; Acute lymphoblastic leukemia; chemotherapy
• ISSN: 0971-5851; 0975-2129
• DOI: 10.4103/0971-5851.144990

Abstract Context: Overall cure rates for pediatric acute lymphoblastic leukemia (ALL) have improved; however, the neuropsychological sequelae of ALL treatment have not been adequately documented in India. Aims: The present study assesses the immediate effects of ALL treatment on neuropsychological functioning, at the Regional Cancer Center in Chennai, South India. Materials and Methods: Newly diagnosed with ALL patients (n = 24) (aged 6-15 years; 13M:11F) registered between March 2008 and February 2009 were included. Patients who had received high-dose methotrexate (HD-MTX) and cranial radiotherapy (CRT) as part of their treatment were enrolled for the study. Neurocognitive assessments were done to assess various functions such as performance intelligence, visuo-perception, visuo-spatial, perceptual organization, processing speed, planning, working memory, and immediate verbal memory (IVM) (Malin′s intelligence scale); verbal fluency (ideation fluency test) and verbal attention (vigilance test). Three assessments were done during induction (baseline), after re-induction phase (second) and during the maintenance phase (third). Results: The patients performed significantly worse in the third assessment (mean duration from diagnosis 17.48 months) on performance intelligence quotient ( P IQ), visuo-perception, visuo-spatial, processing speed, planning, IVM, verbal attention, and verbal fluency ( P < 0.05), there were no significant changes observed in visuo-perceptual organization and working memory ( P > 0.05). Significant difference was observed between age groups 6 and 10 (41.7%) and 11-15 years (58.3%) in perceptual organization, verbal fluency, and verbal attention ( P < 0.05) and no gender difference was observed across the three assessments ( P > 0.05). Conclusions: Combining HD MTX and CRT had an immediate effect on neuropsychological sequelae among the children with ALL, however, long-term evaluation is recommended to study the long-term effects.